CARE HOMES FOR OLDER PEOPLE
Magna Nursing Home Long Street Wigston Leicestershire LE18 2BP
Lead Inspector Janet Browning Unannounced 1st June 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Magna Nursing Home Version 1.10 Page 3 SERVICE INFORMATION
Name of service Magna Nursing Home Address Long Street Wigston Leicestershire LE18 2BP 0116 2883320 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) magna@highfield-care.com Highfield Care Centres Limited Ravensbank House, Ravensbank Drive North Moons Moat, Redditch, Worcestershire Mrs Susan Brach Care Home (CRH) 36 Category(ies) of Dementia - over 65 years of age (36), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (36) Magna Nursing Home Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: No additional conditional of registration apply. Date of last inspection 26 October 2004 Brief Description of the Service: Magna is a care home providing personal and nursing care and accommodation for thirty-six older people. The home is privately owned by the Southern Cross Group operators of a number of care facilities in the Midlands region and is a purpose built twostorey building with level entry access and access to both floors is accessible by use of the passenger lift or stairs. The home is located close to the town centre of Wigston, close to shops, pubs, the post office and other amenities. The home is easily accessible by private or public transport. An adequate number of toilets, bathing and washing facilities including a choice of lounge and dining areas are sited throughout the premise for residents’ care and comfort. The home has twenty-five single bedrooms sixteen with ensuite and nine without ensuite facilities. There are five double bedrooms without ensuite facilities. The home has a garden to the side of the building which is well maintained and which is accessible to all residents residing on the premises. Magna Nursing Home Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 8 hours and was unannounced. A tour of the premises took place and some staff and, a case tracking of three residents which included examining care records as well as some home records and policies and procedures. One comment card had been received from a relative. None had been received from any other source at the time of writing the report. There was an opportunity to talk with one resident who was able, two relatives and five members of staff. The manager of the home was on the premises throughout most of the inspection. What the service does well: What has improved since the last inspection?
Following an additional inspection, the home has improved their accident reporting procedure and risk assessments. This inspection also resulted in the home improving the maintenance of their equipment and ensuring that care plans are provided for all aspects of needs identified on assessment. The
Magna Nursing Home Version 1.10 Page 6 manager has also improved the home’s recruitment procedure following an issue raised whilst checking references. After complaints about the meals, the menus have been reviewed and relatives have commented on the improvement. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Magna Nursing Home Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Magna Nursing Home Version 1.10 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 5 The home’s comprehensive assessment process and staff experience is such that residents are assured that their needs will be met on admission to the home. EVIDENCE: The category of residents that the home is registered for means that they sometimes have complex needs and the home only accepts residents who require nursing input. Comprehensive assessments of prospective residents are performed prior to admission to the home to ensure that the home is able to meet all needs. For example, one resident, had full assessments for health needs and also risk assessments performed for all areas identified as a risk by another agency e.g. “resistive to any intimate care.” A relative spoken to indicated that they had been involved with the assessment process and had received details of the home. Both the registered manager and deputy manager demonstrated an in depth knowledge and understanding of their residents’ needs which was also reflected in their permanent staff on duty during the inspection. Staff spoken to had received training in dementia care and demonstrated a sensitivity in handling the residents’ needs. For example, one care assistant was observed gently guiding a resident to the toilet, informing them when they were walking
Magna Nursing Home Version 1.10 Page 9 from hard flooring to a carpeted area. This was explained as being a problem of differentia for people with dementia; not able to differentiate between carpet and hard flooring and may think there is a step, putting them at risk of falling. The home offers trial visits for residents in the home of four weeks and one relative stated that she received a handbook about the home’s services. Magna Nursing Home Version 1.10 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 11. Whilst care plans were of a high standard and the home actively sought advice from other health professionals, evaluations were insufficient to ensure that all of the residents’ needs were being met. Some aspect of the medication is insufficient to ensure the safety of residents at all times. EVIDENCE: The care plans produced from the initial assessments were very detailed; especially covering individual aspects of care associated with the residents’ mental health needs. All care staff spoken to indicated that they read the residents’ notes and care plans and felt confident that they had all the information to give the care required. This was demonstrated when talking with staff about the care delivered with them detailing the care required to meet residents’ needs. However, the care plans were not always evaluated either regularly or as instructed in the care plan and when they were evaluated, the content was not detailed enough to establish the effectiveness of the care plans. For example, for a new resident, some care plans had not been evaluated eight weeks after admission. One care plan gave clear details on how to approach the resident for personal hygiene, as this procedure could cause aggression, with a requirement for it to be evaluated in two weeks. This was not evaluated. Another resident was recently put on a liquidised diet, which was not reflected either in the evaluation, or the care plan for nutrition revised. With care staff
Magna Nursing Home Version 1.10 Page 11 relying on both handovers and care plans for information, it is important that care plans are reviewed effectively. There was evidence of the home consulting other health professionals for advice. For example, for one resident with pressure sores, the notes gave evidence of the home seeking advice and assurance on the care being delivered from the community tissue viability nurse. The home also involved a private chiropodist into the home and arranged dentist visits. The risk assessments for the development of pressure sores were giving extremely high scores, which did not always correspond with the residents needs. It is recommended that the home consults with other specialist health professionals for advice on this matter. The medication procedure examined during case tracking indicated that whilst the administration process was sufficient, the daily temperature of the fridge and when it had been defrosted was not being documented. There were times when readings were higher than is recommended with no details of action taken and the fridge at the time of the inspection was heavily covered in frost. All of which could compromise the effectiveness of storage of medication. Magna Nursing Home Version 1.10 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. The home promotes individuality both in routine and meals, which results in residents being able to exercise some control over their lives. EVIDENCE: It is noted that not many of the residents are able to communicate their likes or dislikes, but involvement from relatives and friends is encouraged with staff documenting the preferences of residents. One relative stated: • “My mother has been so much better here; she is allowed to be herself.” Due to the nature of residents’ category, all rooms are locked with residents risk assessed as to their ability to have their own key. The home provides an activities organiser Monday to Friday, who does not have formal qualifications but is enthusiastic with residents. A detailed record was kept of the activities undertaken for each day and the home had recently taken three residents to see a musical at a local theatre. One resident stated; • “Activities could be more imaginative. I would like a computer.” A staff member stated; • “Residents love singers, could do with more entertainment. We dance with residents, they enjoy that.” A lack of activities agenda made it difficult to know what was going to occur each day so it was therefore difficult to know if resident’s preferences were being catered for. One relative stated;
Magna Nursing Home Version 1.10 Page 13 • “I don’t know what xxxx has done today, it would be nice to know.” Other members of the team were noted to involve residents in what they were doing. For example, the laundry assistant was observed chatting to residents and encourages them to assist in folding clothing. Meals are cooked on the second floor and there are two lounges in pleasant relaxed surroundings. Care assistants were observed sensitively assisting some residents as required. It is difficult for the residents to make choices on a daily basis, but the cook has introduced a new menu, which incorporates individual likes and dislikes. For example finger food is offered for those residents who find it difficult to sit down for long periods and one resident had a Halal diet. One resident stated; • “I think the new menu is very good in deed. If I didn’t like it I would ask for something else.” One relative stated; • “My mum has always eaten the food; nicely presented.” Magna Nursing Home Version 1.10 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17, and 18. The home’s procedures for complaints and protection are such that residents and relatives can feel confident that any concerns they have will be listened to and acted upon. EVIDENCE: The home kept a complaints record with details of the complaint and the action taken. Relatives spoken to gave details of feeling confident of being able to complain to the manager and had received copies of the home’s complaints procedure. Advocacy services are promoted with one resident being involved with a service providing visiting and counselling. At the recent election postal votes were offered to all residents and their relatives. The home has a robust adult protection procedure and has used this procedure correctly in protecting the residents residing in the home. Care staff spoken to demonstrated that they were aware of the correct procedures to take if they were suspicious that abuse was taking place but had not received training on adult protection. Magna Nursing Home Version 1.10 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 24, 25 and 26. Generally the premises are in a good condition, but there are some aspects, which could potentially put the residents’ health and welfare at risk. EVIDENCE: The home is on three floors with the ground and first floor for the residents use. There is an enclosed garden with plans for the path to be widened for wheelchair access. The lavatories and bathrooms all have red doors so that residents are able to differentiate them from other rooms. New furniture and fittings have been provided in some rooms and indications were that equipment and specialist adaptations were available for residents. However, some equipment and furniture had been left in areas, which could restrict access for residents. For example, an armchair had been placed inside a lavatory making it difficult to open the door and an old bed was left against a wall in a resident’s room. The home keeps records of water temperature checks and random testing during the inspection indicated that hot water is delivered close to 43 C. One bathroom did give a temperature higher than 43 C but this room was kept
Magna Nursing Home Version 1.10 Page 16 locked and the manager stated that she would deal with this immediately. The home also kept records of maintenance of equipment such as bed rails and wheelchairs. Faulty equipment had been a problem at a recent additional inspection, but this has now been resolved. Evidence was seen of residents having their own possessions in the room. Due to the category of residents, all rooms are locked and residents are risk assessed for their capabilities of being able to use their own key. Liquid soap and hand disinfectant was noted in all rooms, but the rooms used for receiving food from the kitchens and a shower room were in very poor condition which could potentially cause a risk of infection. Magna Nursing Home Version 1.10 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 29 The skill mix and knowledge of the staff within the home plus the home’s recruitment procedure ensures that residents’ needs are met and their safety is maintained. EVIDENCE: The roster of staff indicated that staffing numbers met, and on some days exceeded, the number of care hours as recommended in the Department of Health residential forum. The skill mix was such that a nurse was present on both floors, accompanied by experienced care assistants. Any new employees went through an induction programme with supervision from the nurses over a length of time. Discussions with care assistances indicated that they had adequate knowledge to provide care for the residents in the home. They inter-acted with the residents more than one of the qualified nurses who was on duty. The home had five members of staff with NVQ qualifications, with some members of staff who had achieved their NVQ qualification whilst working within the home, to then leave to start a nursing qualification. Although losing qualified staff, the home should be proud that staff felt confident enough to pursue a career in nursing. Recruitment records checked during the inspection, indicated that the home had a robust recruitment procedure with there being one example of the manager not being satisfied with references given and extra investigation showed them to be false.
Magna Nursing Home Version 1.10 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 38. The management of the home ensures that the home is run in the best interest of the residents, but, although practices within the home are generally safe, some aspects are insufficient to fully ensure the health, safety and welfare of those people who use the service. EVIDENCE: The manager is a qualified nurse with a vast experience in mental health nursing. A knowledgeable deputy manager and competent administration process support her. She demonstrated an open and transparent working atmosphere within the home and gave a clear direction on the home’s philosophy, which was to enable residents to “be themselves”. The manager and providers regularly carried out quality assurance within the home, one of which was the home holding regular meetings for relatives, both as a support mechanism for relatives and for the home to gain their views on the running of the home. These were advertised on the home notice board. Unfortunately, minutes were not kept to evidence these meetings. Indications were that client opinion surveys are held every six months.
Magna Nursing Home Version 1.10 Page 19 Evidence was seen of maintenance records to ensure safety of equipment and to meet regulations such as fire. Notes case tracked indicated that risk assessments were taking place cover many aspects of working practice. However, although the actual moving and handling techniques of the staff observed during the inspection indicated safe practice, one resident was observed to be transported in an armchair with wheels in such a manner that her feet were rubbing along the floor which had the potential of causing harm. Another resident identified as requiring a slide sheet for turning in bed, was observed having care staff using a bed sheet to turn the resident. Following issues raised regarding accidents within the home, the manager has improved both the home’s risk assessment procedure and accident reporting which was evident when inspecting care records and accident book. Actions taken to reduce incidents of accidents is recorded. Magna Nursing Home Version 1.10 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION x 3 3 2 x 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x 3 x x x x 2 Magna Nursing Home Version 1.10 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 7 9 Regulation 14 (2) 13 (2) Requirement Care plans must be evaluated regularly and revised as residents’ needs change. Fridge temperatures must be checked to ensure that medication is being stored safely. Any equipment or unused furniture must be stored appropriately. The serving rooms and shower room must be in a condition as to not cause risk of infection to residents. All moving and handling risk assessment for residents using wheeled armchairs must be reviewed and the home must ensure that all staff are up-dated in correct moving and handling techniques. Timescale for action 27/07/05 27/07/05 3. 4. 22 26 23 (2) 13 (3) 27/07/05 27/07/05 5. 38 13 (5) 27/07/05 Magna Nursing Home Version 1.10 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 7.4 8.3 Good Practice Recommendations It is recommended that care plans are reviewed at least every month and that evaluations reflect the effectiveness of the care prescribed. It is recommended that the home consult other health professionals for guidance on the use of risk assessment tools for identifying residents at risk of developing pressure sores. It is recommended that up to date information about activities to take place and about activities which have taken place are circulated in the home in a format that makes it accessible for both residents and their visitors. It is recommended that all staff receive training on the procedure for adult protection. It is recommended that there is a minimum ratio of 50 of care staff, including bank staff, with NVQ level 2 or equivalent by 2005 3. 12.4 4. 5. 18 28 Magna Nursing Home Version 1.10 Page 23 Commission for Social Care Inspection 5 Smith Way Grove Park Enderby, Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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